Karadjova, Dafina

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Karadjova, Dafina

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Karadjova, Dafina

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Impact of epysiotomy on anal continence in women after vaginal delivery
(Macedonian Association of Anatomists and Morphologists, 2019)
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Lazarova-Stojovska, Aleksandra
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Aim: The purpose of this study to determine the impact of episiotomy use in women after vaginal delivery on the female anal continence Methods: The study was designed as a cross-sectional. It was performed at the University Clinic of Obstetrics and Gynecology, University of "Ss. Cyril and Methodius" in Skopje, Macedonia during a period of one year. The study included 470 women of reproductive age with at least 1 previous vaginal delivery. The following variables were analyzed with regard to their influence on anal continence: use of episiotomy, type of episiotomy, perineal injury and degree of perineal injury. Data was acquired using a questionnaire specially designed for this study. The severity of anal incontinence quantified using St. Mark's Anal Incontinence Score. Results: Both the use of episiotomy and the severity of perineal trauma exerted a significant effect on anal continence. The use of episiotomy has been associated with lower St. Mark’s scores, while higher degrees of perineal trauma, were proven to significantly increase the value of the St. Mark’s score Conclusion: Anal incontinence is an unsettling condition affecting women that is inextricably linked to vaginal delivery. Further studies are needed to prove the benefit of episiotomy, which is traditionally regarded as a protective procedure and a method for prevention of pelvic floor disorders.
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Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia
(Македонско лекарско друштво / Walter de Gruyter GmbH, 2017-06-01)
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Ivanov, Emilija
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Introduction.Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO<jats:sub>2</jats:sub>), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO<jats:sub>2</jats:sub> was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO<jats:sub>2</jats:sub> and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.
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Influence of obstetrically-associated risk factors in assessing anal incontinence in patients post vaginal delivery
(Macedonian Association of Anatomists and Morphologists, 2018)
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Stojoska Lazarova, Aleksandra
Introduction: Anal incontinence (AI) is an inconvenient and limiting medical condition that can cause social and hygienic problems, isolation, low self-esteem and low quality of life. The etiology is multifactorial. Women are eight times more affected than men and the reason is considered to be childbirth. In order to prevent this social, physical and psychological problem, it is necessary to define the risk factors leading to development of such symptoms in female patients after undergoing vaginal delivery. Factors that influence occurrence of anal incontinence in patients after vaginal delivery, have been categorized into obstetric, maternal and fetal factors. Objective: The purpose of this study is to determine the impact of individual obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery, and express it as anal score value. Materials and methods: We designed the study cross-sectional, and developed the research it at the University Clinic of Obstetrics and Gynecology, "Ss. Cyril and Methodius" University in Skopje, Macedonia, in a 3-month period, from August to November 2017. In this study, we engaged patients in their reproductive age, who had undergone at least one vaginal delivery. The degree of incontinence was determined using St. Mark's Anal Incontinence Score (SMIS). Results: In the examined segments, multi-parity (at least 2 vaginal births) increased by OR = 4.69 (95% CI 2.04-10.82) the patient's risk of having St. Mark’s score of ≥8 and this is statistically significant difference. Induced labor also reduced the likelihood of OR = 0.39 (95% CI 0.15-1.04) for St. Mark’s score of ≥8, but the difference was not a statistically significant one. Use of mediolateral episiotomy had protective significance against the risk of St. Mark score of ≥8. Conclusion: Results of this study show consistency with data published so far on the influence of obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery. Changes in anal incontinence are expressed in increased St. Mark’s score. Our study showed that the following factors had statistically significant impact on the score value: multi-parity, fetal macrosomia and perineal injury (grades 3 and 4).
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Echocardiographic Heart Changes in Pregnancies Complicated with Gestation Hypertension and Preeclampsia
(International Scientific Invention Journals, 2019-02-13)
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Milkovski, Daniel
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Introduction: Echocardiography as an imaging method is increasingly being used in obstetrics in the management of hemodynamic changes which occur in normal but also in pregnancies with gestational hypertension/preeclampsia. Aim: The aim of the study is to show that some of the heart changes in pregnancies complicated with gestational hypertension and preeclampsia are abnormal and further follow up of these patients is needed. Methods: A total of 81 patients were enrolled in the study. The patients were further divided in two groups. Pregnant women with gestational hypertension or preeclampsia (51) and a control group of normotensive pregnancies (30). A total of 3 echocardiograph exam were made, the first upon entry in the study (28 -34 g.w), the second 2 weeks after delivery and the last 6 months after delivery. Results and discussion: We found several statistically significant results that involve the IVS, PWLV, LKM, left chamber hypertrophy and diastolic function. Diastolic dysfunction usually shows up before systolic dysfunction in the evolution of ischemic/hypertensive cardiovascular disease and is of prognostic value in predicting long term cardiovascular morbidity. The changes seen 6 months after delivery on our last control mean that those changes are permanent and need further prevention strategies. Conclusion: From the noninvasive methods echocardiography is the most favorable method in identifying structural changes and functional changes in pregnancies with hypertension. Echocardiography allows fast, reproducible information and is both safe for mother and fetus.
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Side Effects of Intravenous Patient-Controlled Analgesia with Remifentanil Compared with Intermittent Epidural Bolus for Labour Analgesia - A Randomized Controlled Trial
(Walter de Gruyter GmbH, 2019-12-01)
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Ivanov, Еmilija
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Epidural analgesia is considered a gold standard in obstetric anaesthesia and analgesia. However, in situation when it is contraindicated, unwanted by the patient or simply unavailable, remifentanil can be an excellent alternative. The goal of our study is to analyse the side effects of intravenous patient-controlled analgesia (IV PCA) with remifentanil compared with epidural analgesia during delivery.
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Influence of Spinal and General Anesthesia on Newborn’s Status
(Македонско лекарско друштво / Walter de Gruyter GmbH, 2015-06-01)
Ivanov, Emilija
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Nikolovski, Sotir
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Curlinov, Kiro
The number of caesarean sections has drastically increased and thus arose the idea to examine the effect of the type of anesthesia on the neonates. The objective was to compare vital parameters in the neonates, born under general and spinal anesthesia.Method. A total of 120 patients with need for caesarean section have been divided in two groups of 60, of which the first was lead in general and the second one in spinal anesthesia. The first one was given propophol (2.0-2.5 mg/kg/tt) and succinil colin (1-1.5 mg/kg/tt). The anesthesia was lead with fentanil 0,005 mg/kg/tt and rocuronium bromide 0.4-0.6 mg/kg/tt. The second group was lead in spinal anesthesia. 2-3 ml Bupivacain 0.5% was spinally applied . Apgar score was defined in the neonates in the first and fifth minutes. The acido-basic status of the neonate was examined through pH values in the blood and the base excess.</jats:p><jats:p>Results. In the first minute after birth giving with Apgar, 8 newborns 37(61,67%) were born to the group of patients with SA and 29 (48.33%) to the group of patients with GA. In 11 (18.33%) newborns born to the patients led with SA had Apgar score of 9-10, while only 3 (5%) of the newborns born to the patients led with GA had Apgar score of 9-10. Similar ratio was noted in the fifth minute after birth. Ph of the newborns’ blood as well as the base excess (BE) demonstrated significantly lower values in the group of patients led with SA than in the group of patients led with GA. Ph = 7.33 vs 7.37; BE=-4.57±1.8 vs -2.96±2.3.</jats:p><jats:p>Conclusion. The newborns from the second group had significantly higher Apgar scores than those in the first group. The newborns’ relative acidose (lower SpO<jats:sub>2</jats:sub>and BE) did not affect the newborns’ Apgar score in the first and fifth minute.</jats:p>
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COMBINED SPINAL-EPIDURAL ANESTHESIA FOR ABDOMINAL HYSTERECTOMY IN PATIENTS WITH COPD
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, 2017-04)
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Ivanov E
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Introduction: All patients with chronic obstructive pulmonary disease (COPD) are with increased risk for intra and postoperative complications during abdominal surgery. In our study we present another approach in anesthetic management in these highly risk patients. Methods: We analyzed 20 patients, ASA III, scheduled for elective abdominal hysterectomy. After appropriate preoperative preparation in every patient epidural catheter was placed on Th12 - L1 or L1-L2 level, while spinal punction with standard spinal anesthesia was performed on lower levels. We evaluate basic hemodynamic parameters, patients’ satisfaction and postoperative pulmonary complications.Results: All hemodynamic parameters showed decrease in the first 30 minutes and then constant flow until the end of surgery. 4 patients developed postoperative pulmonary infection, and ended well. All patients were very satisfied with anesthesia procedure.Conclusion: Combined spinal-epidural anesthesia provides good hemodynamic stability, large patients’ satisfaction with fewer postoperative pulmonary complications in patients with COPD. Encouraging this anesthesia technique might increase the safety margin of surgery in patients with severe pulmonary diseases.
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MANAGING CRITICAL ILL CHILD WITH ACUTE RESPIRATORY FAILURE
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, 2017-04)
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Ristovski S
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Children with acute respiratory failure (ARF) present the commonest group of critical ill patients for admission in pediatric intensive care unit (PICU). Respiratory developmental differences between children and adults render this susceptible group to altered response to disease process, various clinical manifestations and interventions for respiratory failure. Appropriate decisions for a proactive and life-saving management of the critically ill child with ARF can be provided recognizing three distinctive clinical profiles: mechanical dysfunction of airways, neuromuscular and breathing dysfunction. Beside this, assessment of many physiologic variables of the respiratory system in children with ARF helps in identification of the development of the respiratory failure and serves as a guide therapy for good outcome. Therapeutic modalities and strategies for respiratory failure in children vary depending on the underlying cause. Interventions include supportive and specific therapy. Maintenance of body temperature is of major importance while fluid therapy, monitoring and assessment are additional necessary measures that are undertaken at first. Supportive therapy include securing the airways, oxygen by mask, nasal cannula or head box, proper positioning, nebulization if indicated, and physiotherapy. Specific measures include oxygen therapy and mechanical ventilatory support. Prognosis and outcome depend on the presence of the disease on admission using a number of scoring system, appropriate follow up and adequate therapeutic treatment.
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Epidural Anesthesia for Caesarean Section and Occurrence of Horner’s Syndrome
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2017-06-01)
Spasovski, Sasho
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Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.
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Neuraxial Anesthesia in the Geriatric Patient
(Frontiers Media SA, 2018)
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Ivanov, Emilija
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Neuraxial anesthesia is recommended as a well-accepted option to minimize the perioperative side effects in the geriatric patients. The available data from the current researches have shifted the focus from the conventional approach to spinal anesthesia to the concept of low dose local anesthetic combined with opioids. What remains clear from all these studies is that hemodynamic stability is much better in patients who received low-doses of intrathecal bupivacaine in combination with opioids, which is possibly result of a potent synergistic nociceptive analgesic effect and their minimal potential effects on sympathetic pathways thus minimizing spinal hypotension. Spinal anesthesia with 5-10 mg of 0.5% heavy bupivacaine, fentanyl 20 mcg and 100 mcg of long-acting morphine added to the perioperative plan decreased the incidence of spinal hypotension and improved perioperative outcomes in the geriatric patients undergoing (low segment) surgical procedures. These findings may be of interest in the gynecologic geriatric surgery also in which area there are very few studies concerning the use of low-dose concept.

Karadjova, Dafina

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